Care Plan
First steps to consider
- It’s important to see a healthcare provider, either your primary care provider, or a behavioral health provider (psychologist, social worker) to get a diagnosis and discuss a treatment plan.
- Depression is often best treated with a combination of therapy, lifestyle changes, and antidepressant medication.
Emergency Care
If you have thoughts or plans of hurting yourself, call 911 or 988 (the Suicide and Crisis Lifeline).
Types of depression
Depression is a mental illness that causes a low mood, feeling of sadness, irritability, and an inability to enjoy the things you used to. But there are different types of depression, and they vary based on the levels of depression, when they tend to occur, and what may trigger it.
The treatments may vary some, but all depressive disorders can be treated with psychotherapy and sometimes medication.
Symptoms
The symptoms of these disorders are very similar, but their intensity, length of time they persist, and triggers may differ. Symptoms include:
- Depressed mood: feeling sad, empty, hopeless, discouraged, or “down in the dumps”
- Decreased interest or pleasure in most or all activities
- Unplanned weight loss or weight gain
- Changes in appetite: may have to force yourself to eat or may crave carbohydrate-rich foods
- Changes in sleep patterns: trouble falling asleep, waking up in the morning, or may sleep more than usual
- Restlessness: hard to sit still, pacing, pulling at your skin or hair
- Slower movement and speech
- Feeling low energy nearly every day
- Difficulty concentrating (or focusing)
- Feelings of worthlessness or excessively placing blame on yourself
- Thoughts that life is no longer worth living
Are there different degrees of depression?
There are many types of depressive disorders and although many of the symptoms overlap, different types vary in intensity, frequency, duration, and cause. All of the depressive disorders often share other symptoms, like a low mood and loss of interest in things you generally care about. —Dr. Bobbi Wegner
Major depressive disorder
Major depressive disorder (MDD) is a serious mood disorder. It is much deeper than just feeling sad or depressed. You feel continual sadness and loss of enjoyment in daily life that lasts for more than 2 weeks. Depression changes how you experience the world and comes with a variety of physical symptoms as well. It is also called clinical depression.
According to the 2017 National Survey on Drug Use and Health, MDD affects 7% of adults. It can happen at any age, and in children too. But it usually begins in the teens or 20’s. It is treated with therapy or a combination of therapy and medications. More than 80% of people improve with treatment.
Persistent depressive disorder
Persistent Depressive Disorder (PDD), also known as dysthymia, is like a low-grade depression that is a constant feeling and lasts a long time. The symptoms of dysthymia are similar to other depressive mood disorders, but they tend to be less intense and are long-lasting (chronic).
Symptoms of PDD develop slowly, often beginning in adolescence or young adulthood. Many people with PDD can recover with ongoing talk therapy and medications.
Depressed mood
Many people may have depression but don’t meet the full criteria of major or persistent depressive disorders. Still, their mood causes significant distress or issues in their life.
Depending on your symptoms, you may have either other specified or unspecified depressive disorder. The main symptom of these two disorders is a depressed mood that is persistent, heavy, and different from typical feelings of sadness, disappointment, or apathy.
Many people with depressed mood will also feel a loss of interest or pleasure in things they once enjoyed. A depressed mood is often "invisible" since many people with it are still able to work or go to school or activities as if nothing was wrong.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) causes low mood, irritability, and anxiety that occurs about a week before you get your period. It usually improves once your period is over. It affects around 2% to 6% of menstruating women of all ages.
Along with the typical symptoms of depression, you may have physical symptoms like breast tenderness or feeling bloated. The best way to help manage PMDD is through healthy lifestyle habits like good sleep, regular exercise, and a healthy diet. If you continue to have symptoms, your doctor may recommend a prescription antidepressant (SSRI).
Substance/medication-induced depressive disorder
The symptoms of this disorder are the same as those of major depression. The difference is that these symptoms are caused by consuming a substance like illegal drugs, medication, or alcohol.
The depressive symptoms usually go away when you stop consuming the substance that’s causing the problem.
Often, people with depression cope by drinking, and symptoms will persist whether a person stops drinking or not. With substance-induced depressive disorder, the depression will go away once the substance is not in the system.
Other symptoms in addition to depressive symptoms
- Recurring physical or psychological problems due to substance use
- Relationship issues related to substance use
- Disruption in your ability to manage responsibilities (work, home, relationships)
- Taking more substance than you want or mean to
- Unable to cut down
What are the signs of depression in a child?
Children often experience depression as irritability, stomach aches/headaches, and change in behavior. —Dr. Wegner
Depressive disorder due to a medical condition
Symptoms of depression can be triggered by having another medical condition. This is quite common as medical conditions often affect how people see themselves and how they engage with the world.
If someone has a serious medical condition, life is almost always impacted and sometimes even threatened. Psychological support is often recommended for people with medical conditions because feelings of hopelessness, lack of control, uncertainty, change in identity, and relationships, all contribute to a person’s mood.
Mood dysregulation disorder
Mood dysregulation disorder occurs in children. They tend to be irritable or angry much of the time, and have intense emotional outbursts more than 3 times a week. It shows up in children between the ages of 6 and 10.
Because symptoms tend to be disruptive, these children also struggle with family, peer, and school relationships, which can make symptoms worse. Treatment includes seeing a behavioral health specialist, who can help understand what emotion is driving the behavior. They also help the parents understand how the family may be contributing to the behavior and how to manage the symptoms.
Symptoms
- Intense verbal or behavior outburst of anger about 3 or more times per week, for at least 12 months in multiple settings (home, school, and/or with friends)
- Underlying mood is irritable, angry, or sad
- Outbursts do not match the child’s developmental age.
Next steps
Trust your gut. If you’ve felt these symptoms for some time and wonder if you have a depressive disorder, get help. You can start by talking with your primary care doctor who can share some treatment options and connect you with a mental health provider.
There are different types of mental health clinicians—therapists do psychotherapy and psychiatrists prescribe medication. If you or someone you know is having thoughts of hurting themselves, call 911 or go to your closest emergency room.
Causes
The reason people develop different types and levels of depression is complex. There are many biological, psychological, and environmental factors.
- Brain chemistry: Neurotransmitters play a huge role in regulating mood. When these chemicals are out of balance, it can cause depression.
- Genetics: Depression runs in families. If you have a family history, you have a higher likelihood of having depression.
- Environmental or psychosocial stressors: Adverse life events (like lack of financial stability, loss, transition) can cause depression.
- Depression often occurs along with substance use, anxiety, personality disorders, and chronic medical conditions (like diabetes, cancer, heart disease, thyroid issues).
Is depression temporary?
You might only experience one depressive episode or depression might come and go for life. The good news for people who have to manage depression over a lifetime is that you begin to notice warning signals before an episode becomes serious. —Dr. Wegner
Treatment
Treatment may include a combination of therapy, medications, and lifestyle changes. The good news is that 80% to 90% of people with depression eventually respond well to treatment.
Psychotherapy
Psychotherapy is often the first approach for most types of depression. There are different types of therapy although cognitive behavioral therapy (CBT) is often used.
CBT helps you recognize negative thought patterns and replace them with more positive ones. Depending on the severity of the depression, medication may be added to the treatment too.
Medications
There are many antidepressants that treat depression. Your doctor or psychiatrist will recommend the best one for you. They will consider symptoms, other medical conditions, and any concerns about side effects. (Side effects vary in each medication.)
It can take up to 2 to 3 months to notice a full positive change from antidepressants. Though for some people, they may notice an improvement in their mood in 2 weeks. You may have to go through some trial and error before finding the right medication.
Some medications your doctor might consider:
- Selective serotonin or norepinephrine reuptake inhibitors (SSRIs and SNRIs): SSRIs are usually the first antidepressant that people try. Common ones are fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). Never stop taking them without checking with your doctor. They will slowly decrease your dose.
- Atypical antidepressants: You may be prescribed bupropion (Wellbutrin) for low energy and poor concentration. Mirtazapine (Remeron) is a good choice if you have very little appetite.
- Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older antidepressants and not often used anymore. But your doctor may suggest one if other medications aren’t working. TCAs have more side effects than SSRIs and SNRIs. MAOIs can be hard to take due to strict dietary restrictions.
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